Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis
A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Bioscientifica
2018-05-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-18-0031 |
| _version_ | 1818028799123521536 |
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| author | Clarissa Ern Hui Fang Mohammed Faraz Rafey Aine Cunningham Sean F Dinneen Francis M Finucane |
| author_facet | Clarissa Ern Hui Fang Mohammed Faraz Rafey Aine Cunningham Sean F Dinneen Francis M Finucane |
| author_sort | Clarissa Ern Hui Fang |
| collection | DOAJ |
| description | A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m2). Dipstick urinalysis showed ketonuria and glycosuria. Blood results were consistent with diabetic ketoacidosis (DKA), with hyperosmolar state. We initiated our DKA protocol, with intravenous insulin, fluids and potassium, and we discontinued risperidone. His obesity, family history of T2DM, acanthosis nigricans and hyperosmolar state prompted consideration of T2DM presenting with ‘ketosis-prone diabetes’ (KPD) rather than T1DM. Antibody markers of beta-cell autoimmunity were subsequently negative. Four weeks later, he had modified his diet and lost weight, and his metabolic parameters had normalised. We reduced his total daily insulin dose from 35 to 18 units and introduced metformin. We stopped insulin completely by week 7. At 6 months, his glucometer readings and glycated haemoglobin (HbA1c) level had normalised. |
| first_indexed | 2024-12-10T05:09:32Z |
| format | Article |
| id | doaj.art-2fe9b27681b74ce497d592ec337aaae1 |
| institution | Directory Open Access Journal |
| issn | 2052-0573 2052-0573 |
| language | English |
| last_indexed | 2024-12-10T05:09:32Z |
| publishDate | 2018-05-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-2fe9b27681b74ce497d592ec337aaae12022-12-22T02:01:09ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732052-05732018-05-01111410.1530/EDM-18-0031Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosisClarissa Ern Hui Fang0Mohammed Faraz Rafey1Aine Cunningham2Sean F Dinneen3Francis M Finucane4Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, IrelandBariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland Galway, Galway, IrelandBariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, IrelandBariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland Galway, Galway, IrelandBariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland Galway, Galway, IrelandA 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m2). Dipstick urinalysis showed ketonuria and glycosuria. Blood results were consistent with diabetic ketoacidosis (DKA), with hyperosmolar state. We initiated our DKA protocol, with intravenous insulin, fluids and potassium, and we discontinued risperidone. His obesity, family history of T2DM, acanthosis nigricans and hyperosmolar state prompted consideration of T2DM presenting with ‘ketosis-prone diabetes’ (KPD) rather than T1DM. Antibody markers of beta-cell autoimmunity were subsequently negative. Four weeks later, he had modified his diet and lost weight, and his metabolic parameters had normalised. We reduced his total daily insulin dose from 35 to 18 units and introduced metformin. We stopped insulin completely by week 7. At 6 months, his glucometer readings and glycated haemoglobin (HbA1c) level had normalised.https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-18-0031 |
| spellingShingle | Clarissa Ern Hui Fang Mohammed Faraz Rafey Aine Cunningham Sean F Dinneen Francis M Finucane Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis Endocrinology, Diabetes & Metabolism Case Reports |
| title | Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis |
| title_full | Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis |
| title_fullStr | Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis |
| title_full_unstemmed | Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis |
| title_short | Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis |
| title_sort | risperidone induced type 2 diabetes presenting with diabetic ketoacidosis |
| url | https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-18-0031 |
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